Provider Demographics
NPI:1689347130
Name:PHOENIX COUNSELING SERVICE, INC.
Entity Type:Organization
Organization Name:PHOENIX COUNSELING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-956-5059
Mailing Address - Street 1:107 S TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4203
Mailing Address - Country:US
Mailing Address - Phone:813-956-5059
Mailing Address - Fax:
Practice Address - Street 1:107 S TAYLOR RD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4203
Practice Address - Country:US
Practice Address - Phone:352-389-1816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health